Nerve Blocks Efficacy

Viewing 5 posts - 1 through 5 (of 5 total)

Author

Posts
Pinales
Member

August 20, 2014 at 12:42 pm

Post count: 18

#11303

Hello Dr. Corenman,

I contacted you first in 2011 and again in 2012. My problem with upper cervical dysfunction is not resolved. Would you please answer another question:

My MRI shows osteophytes in C2, C3 and C4, one enters the spinal cord.
My major paresthesia, pressure, and burning is in the occipital region and on top of my head. My neck is very restricted in all directions. My shoulders, and the trigemenial regial of my head are also tight. Also have unilateral tinnitus on the right side.

My questions: I’ve had three nerve blocks with little result. Could this be because only one nerve is relieved and I am still feeling the others?
Shouldn’t I at least feel numbness?
A new pain specialist wants to do another facet block. Is there good reason to agree or will it still be futile? Do nerve blocks sometimes not work in the upper cervical area?

The neurosurgeon wants a nerve block to verify what is seen on the MRI. Otherwise, he will do nothing. He said then it would be easy to “clean it out.” Aren’t there many reasons for this type of dysfunction? I’m afraid he won’t look for all of them…just remove the osteophyte. He is a chief neurosurgeon at a prominent teaching hospital.

This has now lasted more than five years and has strongly impacted my life.

Thank you, as usual, for any response.

Judith

Donald Corenman, MD, DC
Moderator

August 20, 2014 at 10:16 pm

Post count: 8660

#11308

Osteophytes normally develop from the disc space or the facets. I will assume that the osteophyte does not “enter the spinal cord” but does project into the spinal canal.

Osteophytes are due to degeneration of these structures. Pain is generally related to the erosion of the facet surfaces and “grinding” of these ridged surfaces agains each other.

The facet blocks you mention generally are diagnostic but not therapeutic. This means that the lidocaine (numbing agent) injected should give you 2-3 hours of relief as you have numbed these structures. Long term relief which is a function of the steroid also injected is more uncommon.

If you obtained short-term relief from the injection in the first three hours, this was a diagnostic block meaning the structure injected was the pain generator. In this case, the next step normally is a rhizotomy or burning of the sensory nerve that supplies this joint.

“Cleaning it out” may not give you the relief that you desire.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

Pinales
Member

August 21, 2014 at 12:08 am

Post count: 18

#11313

I certainly still had symptoms. My thought is that with more than one area affected that there would not be significant relief? Correct? But I should have still felt some numbing, right? With all the symptoms, I didn’t notice the relief and certainly didn’t notice any numbing.

Do cervical blocks sometimes just not work?

Yes, when he said “cleaning it out” it made me nervous…but he is supposed to be a very well known neurosurgeon. Maybe, I need to get my courage up and talk to him. He is very confident when he speaks and it is hard to question him.

Thank you so much for such a quick response. I hope I am not emailing you another five years from now!

Judith

Pinales
Member

August 21, 2014 at 12:10 am

Post count: 18

#11314

I should add that with one of the nerve blocks, my tinnitus stopped for an hour or so.

Thanks again.

Donald Corenman, MD, DC
Moderator

August 23, 2014 at 2:20 am

Post count: 8660

#11326

Tinnitus is related to the acoustic nerve which does not exit the skull. There are some cervical disorders that can affect tinnitus but the temporary retreat of this “noise” does not help diagnosis.

If you underwent the nerve block and had absolutely no temporary relief for three hours, most likely the structures injected were not part of the pain generators. There is the slight chance that the block was not performed correctly but I will have to assume that this injectionist “did a good job”.

Now if you had partial relief (40-50%), then possibly you have more pain generators and only some were anesthetized.

You need to talk to this surgeon and he must be able to give you good answers that make sense to you. Don’t be awed by his position.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
Author

Posts

Viewing 5 posts - 1 through 5 (of 5 total)

You must be logged in to reply to this topic.

Donald Corenman, MD, DC

Average rating:

81 reviews

Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

Submit your review
First Name, Last Initial:
Email:
Review Title:
Rating:	1 2 3 4 5
Review:

Check this box to confirm you are human.
Submit Cancel